Provider Demographics
NPI:1639769953
Name:PRIME LABS LLC
Entity Type:Organization
Organization Name:PRIME LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-645-7400
Mailing Address - Street 1:10619 S JORDAN GTWY STE 125
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4073
Mailing Address - Country:US
Mailing Address - Phone:385-645-7400
Mailing Address - Fax:385-645-7419
Practice Address - Street 1:10619 S JORDAN GTWY STE 125
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4073
Practice Address - Country:US
Practice Address - Phone:385-645-7400
Practice Address - Fax:385-645-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory